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California rates for HCPCS E2389

Power wheelchair accessory, foam caster tire, any size, replacement only, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.09 / $14.40 / $92.48
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.65 / $1.83 / $55.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.30 / $24.25 / $41.15
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.01 / $39.01 / $39.01
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.32 / $19.61 / $32.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.16 / $21.16 / $26.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.98 / $21.16 / $37.50
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.18 / $26.18 / $31.42
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.60 / $22.87 / $44.10
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.00 / $151.87 / $153.85
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.47 / $21.16 / $32.95
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.98 / $21.16 / $22.57
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.49 / $60.49 / $60.49
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.91 / $25.91 / $26.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.99 / $15.99 / $35.06